Accelerating Dissemination: Understand Disparities and Partner with Communities

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Accelerating Dissemination Understand
Disparities and Partner with Communities

• William E. Cunningham, M.D., M.P.H.
• Professor of Medicine and Public Health, UCLA

NIH Panel May 9, 2008
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Disclosures
Accelerating the Dissemination and Translation of
Clinical Research into Practice
The Following Faculty have No Relevant Financial
Relationships with Commercial Interests
Dr. William Cunningham Panel Discussion I
Public and Private-Sector Partners for
Collaborative Translation
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Disparities in Healthcare

• Racial, ethnic, and socioeconomic disparities in
  care are common
• General populations, older populations, children
• Disease populations - CVD, CA, HIV, pain
• Diagnostic, therapeutic, preventive care

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Ways to Address Disparities

• Document disparities, explain them

• Examine changes in disparities, explain

• Evaluate interventions among minorities
• Anticipate disparities, prevent them

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Time Trends in Health Care Disparities

• Disparities greatest when treatment new
• Magnitude of disparity diminishes over time
• Disparity reverses when new treatment replaces
  standard treatment
• Best chance to prevent disparities is to reduce
  initial gap

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Diffusion of Innovation
Late Adopters
Use in new technology
Early Adopters
Time
Source Rogers, 1995
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Percent on HAART by Race in HCSUS
P.002
P.24
P.001
P.001
Eisenman, Cunningham. Diffusion of HAART AIDS
Patient Care 2007
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Community Partnership Needed to Address
Disparities

• Many new technologies are being developed, but
  they dont always reach people who need them.
• Minorities, low SES groups often late adopters,
  encounter barriers to accessing treatment
• Phase II translational research needed to
  disseminate new technologies to needy groups
• Partnering with affected communities essential
  for dissemination research and addressing
  disparities
• Lenfant C. Clinical Research to Clinical Practice
  - Lost in Translation? N Engl J Med
  2003349868-74.

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Community-Based Participatory Research (CBPR)

• A collaborative approach to research that
  equitably involves all partners in the research
  process and recognizes the unique strengths that
  each brings.
• --W.K. Kellogg Foundation (2001)

Community Partnered Participatory Research
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Successful Community Partnership

• Develop meaningful partnerships
• Respect community diversity
• Identify and mobilize community assets
• Assure long-term commitment
• Promote organic development of thought, networks,
  and cultivate leadership
• Community advisory boards (CABs) are necessary,
  but not sufficient for partnerships

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Summary Recommendations

• Identify communities who are likely consumers of
  technology under development
• Explore whether new technologies are relevant for
  conditions or groups where disparities are common
  or expected
• Be thoughtful about the decision to partner -
  who, why, and how
• Use a memorandums of understanding to guide the
  partnership and reduce conflicts
• Look for win-win scenarios and foster long-term
  relationships

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References

• 1. Jones L, Wells KB. Strategies for Academic and
  Clinician Engagement in Community-Participatory
  Partnered Research. JAMA 2007297(4)407-10.
• 2.Lenfant C. Clinical Research to Clinical
  Practice - Lost in Translation? N Engl J Med
  2003349868-74.

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BACKUP SLIDES

• To follow

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Racial and Ethnic Disparities Background Data

• Infant mortality rates are twice as high among
  African-American infants as whites
• Several minority groups suffer and die
  disproportionately from conditions such as
  cardiovascular disease, diabetes, asthma, cancer,
  and HIV/AIDS.

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Racial and Ethnic Disparities Background Data

• Hispanics and African Americans less likely to
  receive rehabilitative care after traumatic brain
  injury.
• Hispanic and African-Americans receive less
  curative surgery than whites for non-small cell
  lung cancer
• Hispanics less likely to receive smoking
  cessation messages.

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Racial and Ethnic Disparities Background Data

• Hispanics and AA less likely to receive
  colorectal and breast cancer screening, and
  influenza immunization
• American Indians, Hispanic, and AA less likely to
  receive prenatal care
• African-Americans are referred less than whites
  for cardiac catheterization and bypass grafting

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Racial and Ethnic Disparities Background Data

• African-Americans and Latinos receive less pain
  medication than whites for long bone fractures
  and cancer
• African Americans receive fewer referrals to
  renal transplantation,
• African Americans receive lower quality treatment
  of pneumonia, congestive heart failure,
• AA receive less treatment for HIV/AIDS

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Racial and Ethnic Disparities Background Data

• AA have lower utilization of preventive services
  covered by Medicare (e.g., immunizations and
  mammograms),
• AA have lower utilization of several other
  procedures and levels of ambulatory care covered
  by Medicare.